HomeMy WebLinkAbout52742-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52742 Date: 03/11/2026
Permission is hereby granted to:
Olivia Foschi
PO BOX 119
New Suffolk, NY 11956
To:
construct additions and alterations to an existing single-family dwelling as applied for.
Premises Located at:
395 Kouros Rd, New Suffolk, NY 11956
SCTM# 117.-6-11.1
Pursuant to application dated 09/10/2025 and approved by the Building Inspector.
To expire on 03/10/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition &Alteration $769.13
CO-RESIDENTIAL $100.00
Total $869.13
��� Building Inspector����
:
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
� ir Town Hall Amiex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Pom k
Telephone (631) 765-1802 Fax (631) 765-95021 r . OU(boldtown, "ggy
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
SPERMIT NO. Building Inspector:_,._._..,,,,
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: -y
OWNER(S) F OPERTY:
Name: Joel Kretschman & Olivia Foschi ETM
l000-117.00-06.00-011.001
Project Address:395 Kouros Road, New Suffolk NY 11956
Phone#:(213) 804-1027 lEmail:jtskl9@gmaii.com
Mailing Address: `?p, gpk I�R, New Suffolk NY 11956
CONTACT PERSON:
Name: Melissa Butler
Mailing Address:206 Lincoln Street, Riverhead NY 11901
Phone#031) 208-8850 Email:mbutler75@mac.com
DESIGN PROFESSIONAL INFORMATION:
Name:Daniel A. Butler
Mailing Address:206 Lincoln Street, Riverhead NY 11901
Phone#:(631) 208-8850 Email:daniel@butler-ae.com
CONTRACTOR INFORMATION:
Name: TBD
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
p . test f dect;
❑Other $
❑New Structure Addition ❑Alteration ❑Re air ❑Demolition Est" "w
Will the lot be re-graded? ❑Yes RNO Will excess fill be removed from premises? ❑Yes 19No
1
PROPERTY INFORMATION
Existing use of property: SF Residence Intended use of property: SF Residence
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ._ No IF YES, PROVIDE A COPY.
I-heck Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by
Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized Inspectors on premises and In building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.4S of the New York State Penal Law.
Melissa Butler
Application Submitted By(print @Authorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk
Melissa Butler
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
Agent
(S)he is the
(Contractor,Agent,Corporate Officer,etc.)
of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief, and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
1.
day of Se.IJ�NI�oe r- , 20 �r
Notary PLIM Sw AS E BRICE Ill
NOTARY PUSUC STATE OP Nr'W
SUFFOL K COUNTY
L.IC.#01 SR0031833
Flit . EIUY,_.�.OWNER Au'rH0111ZATION COW E P 1 /11/ 0(c�j
(Where the applicant is not the owner)
395 Kouros Road, New Suffolk NY 11956
I, UV4 residing at
Melissa Butler
do hereby authorize to apply on
my behalf to the To `f So tllold Building Department for approval as described herein.
O 1 ner's Si nature Date
Print Owner's Name
2
rnn
REScheck, * Web
Compliance Certificate
Project Information
Project Title: 395 Kouros Road-Renovation/Addition
Energy Code: 2018 IECC
Location: Cutchogue, New York
Construction Type: Single Family
Project Type: Addition
Project Sub Type: None
Glazing Area: 24%
Climate Zone: 4a (5572 HDD)
All Electric: false
Is Renewable: false
Has Battery: false
Has Charger: false
Has Heat Pump false
Construction Site: Owner/Agent: Designer/Contractor:
395 Kouros Road
Cutchogue , NY
Project Notes:
Envelope Assemblies
Prop. Req.
Assembly Gross Area or Cavity Cont. U- U- Prop. Req.
Perimeter R-Value R-Value Factor/ Factor/ UA UA
F-Factor F-Factor
Ceiling 1st Floor: Cathedral 515 49.0 0.0 0.022 0.026 11 13
Ceiling
Ceiling 2nd Floor: Cathedral 594 49.0 0.0 0.022 0.026 13 15
Ceiling
Floor 1:All-Wood Joist/Truss 515 30.0 0.0 0.033 0.047 17 24
Wall 1: Addition East:Wood 150 21.0 0.0 0.057 0.060 6 6
Frame, 16" o.c.
Window 1:Mod Frame 50 0.300 0.320 15 16
SHGC: 0.31
Wall 2:Addition NorLh: Wood 300 21.0 0.0 0.057 0.060 10 11
Frame, 16" o.c.
Window: Wood Frame 45 0.300 0.320 14 14
SHGC: 0.31
Door:Glass Door(over 50% 80 0.300 0.320 24 26
glazing)
SHGC: 0.31
Wall 3: Addition West: Wood 150 21.0 0.0 0.057 0.060 6 6
Frame, 16" o.c.
Window 1:Wood Frame 45 0.300 0.320 14 14
SHGC: 0.31
Wall 4: 2nd FI. Addition 52 21.0 0.0 0.057 0.060 3 3
South:Wood Frame, 16"o.c.
Window 2: Wood Frame 8 0.300 0.320 2 3
SHGC: 0.31
Wall 4: 2nd FI. Addition West: 400 21.0 0.0 0.057 0.060 21 22
Wood Frame, 16"o.c.
Window 3: Wood Frame 30 0.300 0.320 9 10
SHGC: 0.31
Wall 4:2nd FI.Addition 125 21.0 0. 0 0.057 0.060 4 5
North: Wood Frame, 16"o.c.
Window 4: Wood Frame 50 0.300 0.320 15 16
SHGC:0.31
Wall 4:2nd FI. Addition East: 125 21.0 0.0 0.057 0.060 7 8
Wood Frame, 16"o.c.
The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES
NOT provide an estimate of energy use or cost relative to a minimum-code home.
Slab-on-grade tradeoffs are no longer considered in the UA or performance compliance path in REScheck. Each slab-on-grade
assembly in the specified climate zone must meet the minimum energy code insulation R-value and depth requirements.
Compliance Statement
The proposed building design described here i rear &Atv il jQg plans,specifications,and other calculations
submitted with the permit application.The p A � it + as pgneq to meet the 2018 IECC requirements in
REScheck-Web and to comply with the man art rrerpe,its R 5 ,the REScheck Inspection Checklist.
2-
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e
Name - Title ..................._.w_ww _..............__..�,.. �. _ .._.
Signature Date
r4Inspection checklist
Energy Code:2018 IECC
Requirements: 0%were addressed directly in the RESCheck software
Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each
requirement, the user certifies that a code requirement will be met and how that is documented,or that an exception is being
claimed.Where compliance is itemized in a separate table, a reference to that table is provided.
Pre-Inspection/Plan Review
�5un_._,w w _._.. ...._ ...� ...:.:_.. � W Verified..:... ....:...Verified
..
ectiPlans Field
& Ill Pre-Inspection/Plan Review Value Value Complies? Comments/Assumptions
._.........._m_..��..,.........
.. .�.. ....... _...._..... .. .,.,__ .._.,, ...,... _.,... ... ..._ _... ._._ ._. _ ........
1031, Construction drawings and [—]Complies
103.2 documentation demonstrate Does Not
[PR1]1 energy code compliance for the
buildrrtg envelope.`d`hermai omply
envePope represented on [�Not
construction documents. Observable
Not
pplicable
awin
.,,,....,._._....w-.....�........................ ....... u CC.:.:_wwwwww____.._.......,........w�__w ..�.__._�..........�„..,
�.103.1drawings
g...._ ... sand Construction dr..__._. _.m.....__w_..ww.__..._. Complies
103.2, documentation demonstrate
403.7 energy code compliance for Does Not
[PR3]1 lighting and mechanical Comply
systems.Systems serving ([�}Not
multiple dwelling units must Observable
demonstrate compliance with
the IECC Commercial Provisions, 13 Not
Applicable
402.1�Mµrt Heatingltncieaaolb'n equipment......wH�._w :....�w,�..._... www........_�. wwwwww...............�
dd g ating: Heating„ O Complies
3.7 is size Per ACA Manua S Btu/hr Btu/hr
[PR2]2 based on loads calculated per Does Not
ACCA Manual I or other methods °mply
approved by the code official. Cooling: Cooling. [�]Not
Btufhiir• Btu¢/hr Observable
Not
Applicable
Additional Comments/Assumptions:
..._...... ...._.............�.w..l.............. .�w.. z..:..:..w_. Medium:...._.._.......................... .............� _ww ww_ . ._ ..ww_.....:._._._._...
H i g h Impact(Tier ............. _._.�a. __:
ier _........m .__. Impact(Tier 2) 3.....w_:.:....L°v....Impact(Tier 3)
Foundation Inspection
Section.
& Req.113 Foundation Inspection Complies. Comments/Assumptions
__ _� .
3Q3,2.1 ApucuteCtava Cr�veming..is irustal4ed Yo...._......__O Complies ...__........_,_._�.....��w.,�.w_....m.._�,_,,.__�.._.._.,,,�.�_..,.�...
[FOJI]2 protect exposed exterior insuiation and Does Not
extends a rtt0ir urn of 6 in,b0ow
grade. omply
Not
servable
�PJ Not
applicable
_...�.� .�.�.�.....,,.,._, - ... ......d.........,, �..._..._...,,,,, .........................._...,
403 Snow-and ice-melting system Controls ❑Complies
[F
z installed ❑Does Not
Comply
[[��]]Not
Qbservable
Not
Applicable
Additional Comments/Assumptions:
.....d_�.! .h...lmpact(Tier 1)-w.- ......._.........._,_2k Medium Ima... e ......... _. w ._..... .w�...... M._....., __
. .w... ... ._w....._.,.....�.i,..w... 4 x....� _�.._R..
(T Ct er 2) 3 Low Im act(Tier 3)
Framing / Rough-In Inspection
..w.. ._.__w ..........___ __ ._._ .._ _._. ..._m __w_...... . ...__ _. ._..... _w_ww....w___... ......_
.w_...__.
Section Plans Field
# Framing/Rough-In Verified Verified
& Req.ID Inspection Value Value Complies? Comments/Assumptions
W 402.1.1, _.. glazing U-factor(area-weighted ry Complies Sage the Envelope402.3.1, average). tp 1p� O Does Not Asserr blips table for
402.3.3. [] values
402.5 Comply
[FR2]1 Not
servable
Not
pplicable
_. _.................................... _.......... _...v__ _, .ww...m._..M..........
402.4.1.1 Air barrier and thermal barrier (D Complies
[FR23]1 installed per manufacturer's
instructions. Does Not
omply
PNot
6bservable
Not
pplicable
402.4.3 . trd tion that
is astsite meet
AAMA built
... __.... ...... ....... .... _...
ing
and
`(�Complies
QDoes Not
101/I.S.2/A440 or has infiltration �-Omply
rates per NFRC 400 that do not (❑�]Not
exceed code limits. Observable
0 Not
Applicable
_......�._ ._ _ ..w.......n........ ._..............
......_ ._
402.4.5 lC- ated recessed lighting E)Complies
[FR16]2 fixtures sealed at Does Not
housing/interior finish and
labeled to indicate<_2.0 cfm omply
leakage at 75 Pa Not
Observable
O Not
Applicable
--------_. ..... . .. _,,._, _.....,.._. .......... .......................... . _...._....wwww---
403.3.1 Suppl+ and return dur.,ts in attics O Complies
[FR12]1 insulated >= R-8 where duct is Does Not
>=3 inches in diameter and
-_ R-6 whprp<3 inches. Comply
Supply and return ducts in other Not
portions of the building servable
insulated >=R-6 for diameter (�Not
3 inches and R-4.2 for<3 �
inches in diameter. pplicable
_...... _ ._........................ .... ..... ....._ .._w,_............ ........ .. __ __-....m-_.__ _._w�� _........_-
403.3.2 Ducts, air handlers and filter Complies
[FR13]1 boxes are sealed with :C Does Not
joints/seams compliant with
International Mechanical Code amply
or International Residential P Not
Code, as applicable. servable
O Not
Applicable
_....._........_._.. ._ .._..........__..._....................... ....... ..........------_
403.3.5 Building cavities are not used as Complies
[FR15]3 ducts or plenums.
Does Not
omply
( ]Not
Observable
Not
pplicable
Plans Field
���
raming I Rough-in Verified VerifiedComments/Assumptions
& R .113 Inspection Value Value Complies?
403.3.7 Ducts declared to be within the Complies
[FR28]3 conditioned space are either 1) Does Not
completely within the 0
continuous air barrier and within mply
the building thermal envelope, Not
2) buried within ceiling Uservable
insulation in accordance with
Section R403.3.6 and the air Not
handler is located completely p plicable
within the continuous air barrier
and within the building thermal
envelope and the duct leakage
is <= 15 cfnj/100 square feet
of conditioned floor area served
by the duct systern,or 3)the
ceilin?insulation R-valije
'instal installed as ainst and above the
insulated Tuct—to the
proposed ceiling insulation R-
value,less the R-value of the
insulation on the duct.
------.......... ..................... .............
403.4 HVAC pipin�conveying fluids R.= Complies
(FR17]2 above 105 -F or chMe fluids R,[........ Does Not
below 55 PF are insulated to aR-
3. P.Mply
b P Not
servable
PppNot
iicable
..............
403.4.1 Protection of insulation on HVAC Complies
[FR2411 piping. Does Not
Comply
RNot
servable
PNot
pplicable
403.5.3 Hot water pipes are insulated to R= Complies
[FR1812 �t[1-1 ...... Does Not
PlImply
RNot
servable
PNot
pplicable
............................. ............. ......
03 Autornadc or graviity dampers E)Complies
[FR1912 are 4istalled an all outdoor air Does Not
intakes and exhausts, 0 rnply
UNot
servable
Not
p plicable
........... ........
303.1.3 U-factors of fenestration Complies
[FR4]1 products are determined in Does Not
accordance with the NFRC test
procedure or taken from the Comply
default table. QNot
servable
Not
Applicable
Additional Comments/Assumptions:
................ ....... .........
............ .. .....
-w ..............�je I............... 3'
Impact(Tier 2) __L_L
Insulation Inspection
Section Plans Field
# Verified Verified
& Req.113 Insulation Inspection Value Value Complies? Comments/Assumptions
303.1 All installed insulation is labeled O Complies
[IN13]2 or the installed R-values does Not
provided.
omply
RNot
servable
(�Not
pplicable
_._ 1 . ...... r insulation
a .. �m�......w O Complies
e the Envelope
lopefor
402 1.1, Floor insulation R-value. Com lies See the Enve .... .�w.
402 2 6 Assemblies table
[IN1] Wood Wood dam i values
(�Steel Steel ( Not
y
Observable
Not
pplicable
............................w...................................... _......._ . ...m,. ...,,..., -. ...M._.. ..
303.2, Floor insulation installed per :O Complies
402.2.8 manufacturer's instructions and Does Not
[IN2]1 in substantial contact with the
underside of the subfloor, or omply
floor framing cavity insulation is P[]Not
in contact with the top side of --- — ,Observable
sheathing, or continuous
insulation is installed on the 1 A Not
underside of floor framing and pplicable
extends from the bottom to the
top of all perimeter floor
framing members.
2..1.�.�, Wood
o� ... �W � Complies
402.1.t, .Wall insulation R-value. If this is Com lies m���YYWvvv4�See the Envelope
402.2.5, a mass wall with at least /z of Assemblies table for
402.2.6 the wall insulation on the wall values
[IN3]1 exterior,the exterior insulation omply
requirement applies(FR10). Mass Mass o Not
(1 Steel O Steel dbservable
Not
Applicab8e
w. ...........m
303.2 Wall
nufinsulation
instructions.is per ww- w..._.._--ww----- _. _. ._. __...-,`��..Complies
....._. ._...._.._.._......._...ww_--- -------
....._ _ _........_
es Not
Comply
Not
servable
Not
pplicable
Additional Comments/Assumptions:
.._ act __ _ w..._�.... ._.._.._................_ ...........
Hi�.hmI' -t(Tiwerml.�..�-www _ _, _ 2. Medium I ct..(Tier 2..�...__........._..ww.wwww.ww w.w_
Final Inspection Provisions
&_.R.�.. .��_-------
..._ .. . Provisions.. _. w.Ver ue . ..-Vae .Complies?
...._..�...w... Comments/Assumptions Section
Verified
y Final Inspection
w402.1..1 Ceilin insulation R-value.wp^...w_. ..._...........
.....�_w_. w1t p �W ry µ W � plies µ �µ
Com lies See the Envelope
g R Assemblies table for
402.2.1, (��J Does Not values
402.2.2, (]Wood Wood 'Comply
402.2.6 Steel ❑Steel
(F1111 Not
observable
Not
pplicable
. __...__...._.,__._.,,.. .,m--.� ....._.�...�............_..�..www__,_w� .........._..�
303.1.1.1, Ceiling insulation installed per E)Complies
303.2 manufacturer's instructions. Does Not
[F1211 Blown insulation marked every Pm I
300 ftz. p y
Not
servable
PNot
plicable
.. �,.wwww. ..._.._ .. ...... wm..w... _......,...._._...._.�w.__..__ w.ww.....__www_....._...... ........
.w ..
403.1.2 Heat p.....um thermostat installed (Complies
[FI1012 on heat pumps. Does Not
omply
Not
o servable
O Not
Applicable
.........................«.w .W«....,........................ .....�........u......... C..,........ ....w.............,..........,»... .,..��...,.�„ .,,,.........«.,,,.��. .,......, .,,, ... ..,,:«µ.W.... ..�,................».......... ..,...�..,......»...�............,..,.........,.,................
403.5.1 (Jrcuiattng service hot water Complies
[F Ill]2 asystems have autornatic or cce ble reanual controN. Does Not
Comply
Not
observable
0 Not
Applicable
403,6.1 AU mechanir�al ventilation E)Complies
512 system taus not part of tested P Does Not
and ksterd HVAC equipment omplyrneet effi!ac�aa and air flow krnits
per TaWe R463. .1,. Not
servable
Not
pplicable
...._ _.._._.......... .......
..
403.2 Heat water bothers supplying heat O Complies
[17I2612 through one.,or two•pupe Does Not
heabnt sy�stenas�have outdoor [11
setbar' control to tower boiler (:aamply
water temperature based on [�Not
outdoor temperature. Observable
Not
Applicable
403,5.1.1 Heated water circulation Complies
[F128]2 systems have a circulation Does Not
pcirnp, The systern return pipe is ��mply
a dedicated return pipe or a cold water supply pipe.Gravity P Not
and ti'ierrnos-syphon circulation servable
systems are not present. Not
Controls:,for circulating hot �J
water.system purrrps start the Applicable
purnp with signal for heat water
demand within the occupancy.
Coritrois autornatic.alIy turn off
the pt„usage when winter is 41
c:irculkion loop is at set point
Lwnperat:ure and no demand for
taut water'exists.
...........w
..... ... _,,.�� _ µ.. _...... . ... _ �
403.5.1.2 LhertCVC heat trace stetrr.t (Complies
CFI 2912 comply with tEl 5fl'��,1 or UL. Does Not
51.5. Controls autornaticaHy omply
adjust the energy input to the,
heat tracing to maintain the Not
desired water temperature do o servable
the piping. Not
Applicable
Section Plans Field
# Verified Verified
& Req.113 Final Inspection Provisions Value Value Complies? Comments/Assumptions
4015.2 Demand recircWation water Complies
[FI30]2 systems have controls that
manage operation of the pump Does Not
and limit the temperature of the Pomply
water entering the cold water Not
piping to<= 1049F. Pservable
P Not '
pplicable
.................111--.—----...........
403.5.4 Drain water heat recovery units ❑Complies
[F131]2 tested in accordance with CSA
B55.1. Potable water-side Does Not
meassure loss of drain water C—Omply
t recovery units<3 psi for Not
individual units connected to Rservable
one or two showers. Potable
water-side pressure loss of drain Not
water heat recovery units< 2 Ppplicable
psi for hidividual units
connected to three or more
showers.
404,1 90%or more of permanent Complies
[1`1611 fixtures have high efficacy
lamps. Does Not
PImply
RNot
servable
0 Not
Applicable
404.1.1 Fuel gas lighUng systems have ❑Complies
[F123]3 no continuous plot light. Does Not
PImply
RNot
servable
Not
Applicable
............
4013 Compliance certificate posted, ❑Complies
[F17]1
Does Not
Comply
0qNot
servable
PNot
pplicable
303.3 Manufacturer manuals for ❑Complies
[1`118]3 mechanical and water heating
systems have been provided, P Does Not
mply
PNot
'servable
PNot
pplicable
..............
402,23 Vented attics with air iermeable ED Complies
[F122]2 insulation include baZ
adjacent to soffit and eave
vents that extends over Po Does Not
mply
insulation. Not
Rservable
PNot
pplicable
402.2.4 Attic access hatch and door Complies
[F13]1 insulation ��R-value of the ------ ❑Does Not
adjacent assembly. Comply
PNot
'servable
0 Not
Applicable
402.4.1.2 Blower door test @ 50 Pa. <=5 ACH 50 = ACH 50 Complies
[FI17]1 ach in Climate Zones 1-2,and
<=3 ach in Climate Zones 3-8, Does Not
Comply
PNot
'servable
n Not
Applicable
............. ..........—........ ........... ............. ....... ......................
..1, ............. ...........ec ��.�www..._-Final..� � Verified Verified Complies? Comments/Assumptions
& Rpection Provisions Value Value
403.3.3 Ducts are pressure tested to C]Complies
[1`12711 determine air leakage with L__j
either: Rough-in test:Total CfM/100 ft2 CfM/100 ft2 Does Not
leakage measured with a PImply
pressure differenUall of 01 inch Not
w.g, across the system inc6a6n9 Uservable
the rnanufaCtUrer's air handler
enclosure if installed at time of
test. Postconstruction test:Total Pp Not
plicable
leakage measured with a
pressure differential of 0.1 inch
w,g, across the entire system
including the manufacturer's air
handler enclosure.
403.3.4 Duct tip,c htness test result of r--i Complies
[F1411 <=.-4 c V1 00 ft2 across the L_j
system or<=3 Orn/100 ft2 cfm/100 ft2 CfM/100 ft2 Does Not
wlthoi.a air handler (4)25 Pa f'or Comply
rouqh4n tests, verffi adon may Not
need to occur during Frarning Qoservable
Inspection. P Not
wicabie
........... ..........46 3.3.2.1 Air handler lealkage des E)Complies
9
[F12411 by manufacturer at<=2 Yo of Does Not
design air flow, PImply
U Not
servable
Not
Applicable
Og12 Programmable thermostats Complies
Instafled r conrol of rimary
heating anfo d cotolhig sys,pt�ems El Does Not
and initially set try manufacturer Comply
to code specifications, Not
P'servable
PNot
pplicable
Additional Comments/Assumptions:
.............."11111111........... .................. ...........
.......... .............................................. .......... ............
h I pact(Tier 1) Medium Impact(Tier 2) __Lbw ......
-----""-_"__'_',.__"'_.................
.Ww
Efficiency
Above-Grade Wall 21.00
Below-Grade Wall 0.00
Floor 30.00
Ceiling/Roof 49.On
Ductwork(unconditioned spaces):
Window 0.30 0.31
Door 0.30 0.31
Skylight 0.00
Heating _-
Cooling System:............... . ._..........
..._ ___w_ _........,
Water Heater:
Name: Date•
Comments: